Pulmonary Hypertension in Transcatheter Mitral Valve Repair for Secondary Mitral Regurgitation: The COAPT Trial.

MedStar author(s):
Citation: Journal of the American College of Cardiology. 76(22):2595-2606, 2020 12 01.PMID: 33243380Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Cardiac Catheterization/mt [Methods] | *Heart Failure | *Heart Valve Prosthesis Implantation | *Hypertension, Pulmonary | *Mitral Valve | *Mitral Valve Insufficiency | *Postoperative Complications | Echocardiography/mt [Methods] | Female | Heart Failure/et [Etiology] | Heart Failure/pp [Physiopathology] | Heart Valve Prosthesis Implantation/ae [Adverse Effects] | Heart Valve Prosthesis Implantation/mt [Methods] | Humans | Hypertension, Pulmonary/et [Etiology] | Hypertension, Pulmonary/pp [Physiopathology] | Male | Middle Aged | Mitral Valve Insufficiency/co [Complications] | Mitral Valve Insufficiency/di [Diagnosis] | Mitral Valve Insufficiency/pp [Physiopathology] | Mitral Valve Insufficiency/su [Surgery] | Mitral Valve/dg [Diagnostic Imaging] | Mitral Valve/pa [Pathology] | Mitral Valve/su [Surgery] | Postoperative Complications/di [Diagnosis] | Postoperative Complications/mo [Mortality] | Prognosis | Risk Assessment/mt [Methods] | Risk Assessment/sn [Statistics & Numerical Data] | Risk Factors | Severity of Illness Index | Treatment OutcomeYear: 2020Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0735-1097
Name of journal: Journal of the American College of CardiologyAbstract: BACKGROUND: Pulmonary hypertension worsens prognosis in patients with heart failure (HF) and secondary mitral regurgitation (SMR).CONCLUSIONS: Elevated PASP is associated with a worse prognosis in patients with HF with severe SMR. TMVr with the MitraClip reduced 30-day PASP and 2-year rates of death or HFH compared with GDMT alone, irrespective of PASP. Copyright (c) 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.METHODS: In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, 614 patients with HF with moderate-to-severe or severe SMR were randomized to TMVr with the MitraClip plus guideline-directed medical therapy (GDMT) (n = 302) versus GDMT alone (n = 312). Baseline pulmonary artery systolic pressure (PASP) estimated from echocardiography was categorized as substantially increased (>=50 mm Hg) versus not substantially increased (<50 mm Hg).OBJECTIVES: This study sought to determine whether baseline pulmonary hypertension influences outcomes of transcatheter mitral valve repair (TMVr) in patients with HF with SMR.RESULTS: Among 528 patients, 184 (82 TMVr, 102 GDMT) had PASP of >=50 mm Hg (mean: 59.1 +/- 8.8 mm Hg) and 344 (171 TMVr, 173 GDMT) had PASP of <50 mm Hg (mean: 36.3 +/- 8.1 mm Hg). Patients with PASP of >=50 mm Hg had higher 2-year rates of death or HF hospitalization (HFH) compared to those with PASP of <50 mm Hg (68.8% vs. 49.1%; adjusted hazard ratio: 1.52; 95% confidence interval: 1.17 to 1.97; p = 0.002). Rates of death or HFH were reduced by TMVr versus GDMT alone, irrespective of baseline PASP (pinteraction = 0.45). TMVr reduced PASP from baseline to 30 days to a greater than GDMT alone (adjusted least squares mean: -4.0 vs. -0.9 mm Hg; p = 0.006), a change that was associated with reduced risk of death or HFH between 30 days and 2 years (adjusted hazard ratio: 0.91 per -5 mm Hg PASP; 95% confidence interval: 0.86 to 0.96; p = 0.0009).All authors: Abraham WT, Asch FM, Ben-Yehuda O, Chen S, Grayburn P, Hahn RT, Kapadia S, Kar S, Lim S, Lindenfeld J, Liu M, Mack MJ, Medvedofsky D, Puri R, Redfors B, Sannino A, Shahim B, Stone GW, Weissman NJOriginally published: Journal of the American College of Cardiology. 76(22):2595-2606, 2020 12 01.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2021-03-10
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 33243380 Available 33243380

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: Pulmonary hypertension worsens prognosis in patients with heart failure (HF) and secondary mitral regurgitation (SMR).

CONCLUSIONS: Elevated PASP is associated with a worse prognosis in patients with HF with severe SMR. TMVr with the MitraClip reduced 30-day PASP and 2-year rates of death or HFH compared with GDMT alone, irrespective of PASP. Copyright (c) 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

METHODS: In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, 614 patients with HF with moderate-to-severe or severe SMR were randomized to TMVr with the MitraClip plus guideline-directed medical therapy (GDMT) (n = 302) versus GDMT alone (n = 312). Baseline pulmonary artery systolic pressure (PASP) estimated from echocardiography was categorized as substantially increased (>=50 mm Hg) versus not substantially increased (<50 mm Hg).

OBJECTIVES: This study sought to determine whether baseline pulmonary hypertension influences outcomes of transcatheter mitral valve repair (TMVr) in patients with HF with SMR.

RESULTS: Among 528 patients, 184 (82 TMVr, 102 GDMT) had PASP of >=50 mm Hg (mean: 59.1 +/- 8.8 mm Hg) and 344 (171 TMVr, 173 GDMT) had PASP of <50 mm Hg (mean: 36.3 +/- 8.1 mm Hg). Patients with PASP of >=50 mm Hg had higher 2-year rates of death or HF hospitalization (HFH) compared to those with PASP of <50 mm Hg (68.8% vs. 49.1%; adjusted hazard ratio: 1.52; 95% confidence interval: 1.17 to 1.97; p = 0.002). Rates of death or HFH were reduced by TMVr versus GDMT alone, irrespective of baseline PASP (pinteraction = 0.45). TMVr reduced PASP from baseline to 30 days to a greater than GDMT alone (adjusted least squares mean: -4.0 vs. -0.9 mm Hg; p = 0.006), a change that was associated with reduced risk of death or HFH between 30 days and 2 years (adjusted hazard ratio: 0.91 per -5 mm Hg PASP; 95% confidence interval: 0.86 to 0.96; p = 0.0009).

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